What is multiple biloma?

Biloma is collection of bile within the abdominal cavity. It happens when there is a bile leak, for example after surgery for removing the gallbladder (laparoscopic cholecystectomy), with an incidence of 0.3–2%. Other causes are biliary surgery, liver biopsy, abdominal trauma, and, rarely, spontaneous perforation.

What causes biloma?

A biloma is a rare abnormal accumulation of intrahepatic or extrahepatic bile caused by traumatic or spontaneous rupture of the biliary tree1, 2). It is most commonly caused by surgery, percutaneous transhepatic cholangiography (PTC), percutaneous transhepatic biliary drainage (PTBD), and abdominal trauma11, 12).

Is biloma a complication?

The development of an intra-abdominal bile collection (biloma) is an infrequent complication of laparoscopic cholecystectomy (LC). These bilomas develop in the subhepatic space most often secondary to iatrogenic injury of the extrahepatic ducts.

How do you treat biloma?

Large or symptomatic bilomas are treated by percutaneous drainage, in some cases coupled with a biliary drainage procedure to divert bile from the site of injury. External biloma drainage is continued until the biliary output through the drain ceases. Catheter injection often shows the site of leakage.

Is a biloma painful?

The clinical presentation of biloma is variable and it could present with diffused or localized abdominal pain, fever, and jaundice. Rarely, it can cause ascites and peritonitis without fever.

How serious is a bile leak?

Bile leaks are a rare but serious complication of gallbladder surgery. If a bile duct is damaged during surgery, bile may leak into the abdominal cavity, causing extreme pain. Bile leaks are often corrected by placing a stent (narrow tube) in the duct to keep bile from escaping while the duct heals.

Is biloma an infection?

Infected hepatic fluid collections (bilomas) are a major infectious complication of liver transplantation. Limited data exist on management and outcome of biloma. Methods.

How long can you live with a bile leak?

Patients with a bile leak were more likely to die at 1 year (2.4% vs 1.4%; p < 0.001) and 3 years (5.8% vs 4.8%; p < 0.05) when compared with patients without a bile leak (Fig. 2A).

Can a bile leak heal itself?

Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful.

How common are multiple bilomas within a single patient?

Multiple bilomas within a single patient are not rare. The location and size of a biloma are dependent on multiple factors, including the rate, site, and cause of the bile leak, as well as the rate at which the peritoneum absorbs the bile.

What is included in the management of bilomas?

Management of bilomas can also involve treating any associated biliary tract obstruction which can both complicate and cause bilomas. Surgical repair of the source of underlying biliary tract bile leak may also be required. General imaging differential considerations include:

Which quadrant is a biloma typically located?

Seventy percent of bilomas are localized to the right upper quadrant, whereas the remaining 30% develop in the left upper quadrant. A biloma may wall off or may continue to demonstrate active bile leakage. The goals of imaging in the assessment of biloma are:

What is a biloma of the peritoneum?

There is a slight discrepancy in the reported literature in the use of the term “biloma”. Many authors have used it exclusively to refer to intrahepatic bile collections or other bilious collections which are discretely organized rather than free biliary leak into the peritoneum (choleperitoneum: a rarely used term).